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Howard Pomeranz, MD

JAMA. 1998;279:1870.

A recent petition by resident physicians to the National Labor Relations Board¹ has raised the question, how well are resident physicians represented in their residency programs? In response, the American Medical Association (AMA) asked the Accreditation Council for Graduate Medical Education (ACGME) to address this issue. Last week's Resident Forum column discussed the ACGME's recent adoption of a "rapid response mechanism" to deal with alleged egregious accreditation violations by residency programs. The ACGME has also been reviewing its institutional requirements, which contains the standards that each institution must meet in order to sponsor graduate medical education (GME) programs.

The ACGME delegated consideration of this issue to its Institutional Review Committee (IRC), which is charged with the review of institutions sponsoring GME programs. The institutional requirements covers matters such as institutional commitment to provide organizational and financial support for GME; the composition and responsibilities of the institution's GME Committee, which oversees all aspects of GME, including creation and review of all GME policies and procedures and internal review of residency programs; quality assurance activities; resident participation in education activities; resident financial support, benefits and conditions of employment; and resident supervision, duty hours, and work environment.

After considerable deliberation, the IRC proposed the following revisions to the institutional requirements:

• The GME Committee must include a resident physician as a voting member.
  
• The GME Committee must ensure that an institution's educational environment allows questions to be raised and resolved without fear of intimidation or retaliation. This includes providing a formal communication system through which residents can confidentially voice their concerns. This may be accomplished through a resident or house staff organization or through other forums.
  
• Institutions must enact fair policies and procedures regarding the adjudication of resident grievances and regarding disciplinary actions against residents that could result in dismissal or could significantly threaten the resident's career development.
  
• Each year, residents must be given the opportunity to submit to program directors or other designated officials a confidential written evaluation of faculty members and of their educational experience.
  
• Residency programs must not require residents to sign a noncompetition guarantee. For example, a program cannot limit the resident's ability to practice within certain geographic boundaries after completing the residency program.
  
• The institution's contract with the resident must contain or reference provisions for financial support, vacation policies, professional liability insurance, disability insurance, leave benefits, and counseling services. It must also include policies regarding residents' responsibilities, professional activities outside the education program (moonlighting), and grievance procedures.
  

Resident Representative
ACGME Institutional Review Committee

REFERENCES
1. Collective negotiations for residents. JAMA. 1998;279:498j. FREE FULL TEXT

Edited by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.

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